Feds limit Medicaid picks

While the administration has been flexible about numerous aspects of Medicaid expansion called for in the healthcare reform law, there is at least one thing that is not negotiable: States will not get full federal funding from states that go only part way on expanding their Medicaid programs.

It had been a question on many state execs' and providers' minds until Health and Human Services Secretary Kathleen Sebelius made the declaration in a letter to governors in mid-December.

Several states had floated the idea of allowing a partial expansion. The Affordable Care Act says states should expand Medicaid in 2014 to cover anyone earning 138% or less of the federal poverty level. That's around $32,000 for a family of four.

The decision means, for example, that a state can't decide to fund expansions for just up to 90% of the federal poverty level.

HHS noted that it would consider waivers for states in 2017, when federal funding begins to scale back.

About 60,000 elderly or disabled Medicaid recipients in Louisiana are being told they should expect to lose their benefits in July, and advocates say more than a quarter of them could be forced out of the long-term care facilities they call home.